Dental Policy Manager

🔥 5 horas atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $78.000 - $106.000 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

👔 Gerente

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

👻 Score fantasma 0%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Publicada recentemente.
• As vagas desta empresa costumam ser preenchidas em 21 dias.

Candidatar-se

Encontrar Vagas Remotas Similares

Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

Cotiviti é uma empresa de tecnologia e análise em saúde que se especializa em melhorar a precisão e o desempenho dos pagamentos por meio de soluções avançadas de análise de dados. Eles se associam a planos de saúde, agências governamentais e provedores de serviços de saúde para fornecer insights que aprimoram a qualidade e a eficiência na prestação de cuidados. Com soluções como ajuste de risco, gerenciamento de políticas de pagamento e engajamento de membros, a Cotiviti busca otimizar os resultados financeiros e clínicos para o ecossistema de saúde.

Descrição

• Support the accuracy and maintenance of assigned client dental payment policy sets by reviewing change requests, identifying potential impacts, and recommending appropriate updates within established guidelines • Conduct periodic and industry-update analyses for assigned clients using established review processes • Evaluate content changes, identify potential policy impacts, and recommend appropriate updates • Clearly understand and articulate new dental policy rules in an existing Decision Point and present policies to the Dental Director for client presentation • Assist in preparing payment policy documents for client presentation, coordinate review and approval with the Dental Director, and participate in client policy meetings • Serve as the client-facing representative and partner with Dental Clinical Leadership, Content Team, and Compliance • Analyze clinical, licensure, utilization-review, and compliance considerations and coordinate recommendations with subject-matter experts • Review and analyze client inquiries and change requests, apply decisions for affected policies, maintain information, and communicate effectively with clients • Resolve routine and moderately complex client policy inquiries within established parameters and escalate novel, high-risk, or precedent-setting matters • Provide standard policy guidance and recommend action based on established dental payment-policy standards • Analyze policy, claims, and reporting information from multiple sources; identify trends or discrepancies; and communicate findings and recommendations to internal and external audiences • Evaluate and document client-specific policy requirements, sensitivities, and approved exceptions • Coordinate assigned projects using project-management practices, including monitoring timelines, identifying risks, and communicating status • Apply working knowledge of dental policy, claims, inquiry, and reporting applications to evaluate information and support recommendations • Perform day-to-day responsibilities independently within established policies and procedures • Complete performance-review responsibilities, special projects, and other assigned duties

🎯 Requisitos

• Bachelor’s Degree in relevant field or equivalent, such as a Dental Hygienist • Minimum 2 years of experience in dental claims, dental payment policy, dental coding, utilization management/review, payer operations, dental benefits administration, or a closely related field • Demonstrated knowledge of CDT coding, dental terminology, dental claim forms and data, dental reimbursement concepts, and common dental benefit and claim-adjudication practices • Certified Dental Coder or another relevant coding, compliance, utilization-management, or project-management credential • Knowledge of claims management billing systems is preferred • 2+ years’ experience in customer service or client management with a strong focus on healthcare setting • Knowledge of dental claims payment policy, processing, and reimbursement methodologies • Prior experience in developing dental payment policy edits preferred • Strong research capabilities and knowledge of ADA and CDT guidelines and other regulatory compliance guidelines and mandates, and dental payment policies • Knowledge of dental terminology • Clearly understands and articulates dental policies • Effective analytical and problem-solving skills • Professional with ability to properly handle confidential information • A track record of successful outcomes working within a collaborative team environment or highly matrixed structure • Strong interpersonal skills and the ability to work with on-site and remote cross-functional product teams and customers • Computer and technology literate with proficiency in MS Office Suite: Excel, Word, PowerPoint and Outlook • Willingness/availability to travel up to 15% is required • Ability to work with a high volume of transactions, effectively organize, prioritize and meet deadlines • Must be able to perform daily functions with a reasonable amount of direct supervision • Must be able to perform duties with or without reasonable accommodation • Must be able to provide a dedicated, secure work area • Must be able to provide high-speed internet access/connectivity and office setup and maintenance

🏖️ Benefícios

• Medical, dental, vision, disability, and life insurance coverage • 401(k) savings plans • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti • Remote work arrangement • Dedicated, secure work area and high-speed internet access/connectivity and office setup and maintenance provided by the candidate

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo